American Indians, substance use, and HIV risk behaviors: Secondary data analysis of the Summary/Abstract While cumulative evidence clearly indicates that American Indians (AIs) are at a much greater risk of alcohol and illicit substance use/abuse and HIV risk behaviors than other racial and ethnic groups in the U.S., there has been a relative paucity of research that has attempted to explain such behavior, including the race gap-why AIs are at an elevated risk for such behaviors (relative to whites). And of the studies that have attempted to explain such behaviors among AIs, virtually none have employed a rich, nationally representative data set that follows adolescent respondents into adulthood. The present study forwards our knowledge by using the National Longitudinal Study of Adolescent Health (Add Health) data to examine risk and protective factors that serve to explain AI substance use and HIV risk behaviors, comorbid behaviors, and the aforementioned race gap. The long-term goal of this research team is to continue to explore how racial and economic stratification serves to produce health disparities and to facilitate the discovery and implementation of efficacious prevention and interventions to reduce such disparities. The objective of this application is threefold: a) to explore the antecedents of AI substance use and HIV risk behaviors by utilizing the Add Health data; b) to explore the role of contextual factors (school and community) that may directly or indirectly influence AI substance use and HIV risk behaviors; and c) to consider factors that may explain change, amplification, and/or desistance in such behaviors among AIs as they age into adulthood. The central hypothesis of this application is that differences in stress exposure, coupled with differences in coping, personal, and social resources will predict both individual and race-specific variation in substance use and HIV risk behaviors, with contextual factors serving to directly influence and moderate the stress-behavior association. The plan is to fill this knowledge gap by pursuing the following three aims: a) examine the risk and protective factors associated with AI substance use, HIV risk behaviors, comorbid behaviors, and the race gap using a longitudinally, nationally representative sample and informed by a stress process framework; b) analyze the direct and indirect (moderator) role of school and community contextual factors for understanding AI substance use, HIV risk behaviors, comorbid behaviors, and the race gap; and c) study longitudinal processes and factors associated with changes in AI substance use, HIV risk behaviors, comorbid behaviors, and the race gap using the four waves of the Add Health data (including the recently released Wave IV data). The proposed research is significant because it is expected to provide fundamental knowledge necessary in order to construct effective interventions and preventions that will reduce the AI-white race gap in substance use and HIV risk behaviors. PUBLIC HEALTH RELEVANCE: The proposed project serves to help fill a critical gap in our knowledge regarding the etiology of substance use and HIV risk behaviors and have obvious implications for public health policy. Indeed, the results of this study are expected to produce a positive impact by 1) serving as a basis for developing and improving evidence-based intervention and prevention efforts that can reduce health disparities between AIs and whites, 2) helping to identify the personal and social characteristics and the social risk and protective factors that can be used to distinguish at-risk youth most in need of intervention/prevention efforts across AI and white youth, and 3) identifying the unique social contexts where public health promotion campaigns can have the greatest impact.